Heart disease is the most common cause of death and disability in men in the U.S. According to the American Heart Association, 1 in 3 American men suffer from one or more cardiovascular conditions, and every year 1 in 4 of them dies. The nuances of diagnosing, documenting, and coding heart failure and related conditions are numerous. There are major ICD-10 updates to report heart failure in fiscal year (FY) 2018. Medical coding outsourcing is a feasible option to handle coding challenges and submit claims to accurately reflect the severity of illness, which impacts quality and reimbursement.
Heart Failure
The heart’s pumping action delivers oxygen- and nutrient-rich blood to the body’s cells, allowing the body to function normally. Heart failure is a chronic, progressive condition in which the heart muscle is not able to pump enough blood through to meet the body’s requirements. FY 2018 ICD-10 updates include a new subcategory I50.8- to identify and report the several different and specific types of heart failure such as left-sided heart failure and right-sided heart failure.

Left-sided heart failure

The left ventricle provides the main pumping power of the heart and left-sided heart failure occurs when the left side of the heart must work harder to pump the same amount of blood. There are two types of left-sided heart failure:

  • Heart failure with reduced ejection fraction (HFrEF) or systolic failure: The left ventricle loses its ability to contract normally, with the result that the heart is unable to pump with enough force to push enough blood into circulation.
  • Heart failure with preserved ejection fraction (HFpEF) or diastolic failure/dysfunction: This type of heart failure occurs when the left ventricle becomes stiffer than normal and does not relax the way it should. The heart cannot properly fill with blood during the resting period.

Right-sided heart failure

The right heart ventricle pumps blood to the lungs to collect oxygen. Right-sided heart failure occurs as a result of left-sided heart failure. When the left ventricle is unable to pump blood efficiently, the blood backs up in the veins. This typically causes swelling in the legs and ankles, and swelling within the abdomen such as the GI tract and liver.

Congestive heart failure

Congestive heart failure (CHF) is the stage in which fluid builds up around the heart and affects its normal pumping action. If fluid collects in the lungs, it interferes with breathing and causes shortness of breath, a condition called pulmonary edema. Heart failure also affects the kidney function and causes edema or swelling in the body’s tissues.

Biventricular heart failure occurs when heart failure affects both sides of the heart. End-stage heart failure is the final stage of the disease (Stage D).

New ICD-10 Codes and Descriptions for Heart Failure in 2018
In 2018, heart failure coding includes the following changes:

  • I50.810 Right heart failure, unspecified (right heart failure without mention of left heart failure or right ventricular failure)
  • I50.811 Acute right heart failure (acute isolated right heart failure or acute (isolated) right ventricular failure)
  • I50.812 Chronic right heart failure (chronic isolated right heart failure or chronic (isolated) right ventricular failure)
  • I50.813 Acute on chronic right heart failure (acute on chronic isolated right heart failure, acute on chronic (isolated) right ventricular failure, acute decompensation of chronic (isolated) right ventricular failure or acute exacerbation of chronic (isolated) right ventricular failure
  • I50.814 Right heart failure due to left heart failure (right ventricular failure secondary to left ventricular failure)

Code also the type of left ventricular failure, if known (I50.2-I50.43)
Excludes1: Right heart failure with but not due to left heart failure (I50.82)

  • I50.82 Biventricular heart failure

Code also the type of left ventricular failure as systolic, diastolic, or combined, if known (I50.2-I50.43)

  • I50.83 High output heart failure
  • I50.84 End-stage heart failure (stage D heart failure)
  • I50.89 Other heart failure

Other Changes:

  • New guidelines for subcategories I50.2-I50.4 instruct: “Code also end stage heart failure, if applicable (I50.84)”.
  • 150.1 is revised, to “Left ventricular failure, unspecified.”
  • I50.2 Systolic (congestive) heart failure adds two definitions:
    • Heart failure with reduced ejection fraction [HFrEF]
    • Systolic left ventricular heart failure

Code also end stage heart failure, if applicable (I50.84)

  • I50.3 Diastolic (congestive) heart failure adds three definitions:
  • Diastolic left ventricular heart failure
  • Heart failure with normal ejection fraction
  • Heart failure with preserved ejection fraction [HFpEF]

Code also end stage heart failure, if applicable (I50.84)

  • Category I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure adds two definitions:
  • Combined systolic and diastolic left ventricular heart failure
  • Heart failure with reduced ejection fraction and diastolic dysfunction

Code also end stage heart failure, if applicable (I50.84)

  • I50.82 and I50.84 note to “Code also the type of left ventricular failure, such as systolic, diastolic, or combined, if known (I50.2-I50.4)

Deleted inclusion terms: The notes with existing code I50.9 (Heart failure, unspecified) have certain deletions in ICD-10 2018.

  • Biventricular (heart) failure NOS
    The ICD-10 code for biventricular heart failure in 2018 is I50.82
  • Right ventricular failure (secondary to left heart failure)
    The ICD-10 code for right heart failure due to left heart failure in 2018 is I50.814

Fiscal year (FY) 2018 ICD-10 updates include about 360 new codes, 142 deletions, and 226 code revisions. Experienced coders in medical coding companies are knowledgeable about these code updates including inclusion terms and exclusion notes, and can ensure proper code assignment based on physician documentation of the type and acuity of the heart failure. They also have a thorough knowledge of payer rules and guidelines which is critical to ensure proper accurate claim submission and reimbursement.